Greater knowledge gain with structured than student-directed learning in Child Health: cluster randomized trial

The aim of this study was to detect a difference in knowledge gain between students receiving structured versus student-directed learning for the two-week Child Health outpatient module. A total of 138 phase 3 (year 4) medical students in 10 two-week paediatric outpatient blocks at the Department of Child Health, University of Dundee, Scotland, were randomized to student-directed or structured learning between January and December 2002. Pre- and post-course tests were administered at the start and the end of the attachment; 129 students sat both tests. Results are presented as mean scores with standard deviations or 95% confidence intervals (CI) in parentheses. The primary outcome measure was gain in knowledge of the Child Health core curriculum that is covered in the outpatient setting. Although pre-course scores were similar (student-directed 25.3 (7.3); structured 24.8 (7.5)) the structured approach resulted in higher post-course scores in comparison with the student-directed approach (student-directed 41.8 (9.4); structured 53.8 (8.8); p < 0.01). Knowledge gain showed significant differences between the two learning approaches (student-directed 16.5 (3.7); structured 29.1 (3.8), difference = 12.6 (95% CI 11.3 to 13.9)). Low pre-course scores or gender did not affect knowledge gain. In the Child Health outpatient setting, the 'traditional' structured approach led to significantly greater knowledge gain in comparison with the 'novel' student-directed approach. The findings emphasize the importance of careful evaluation of novel medical education strategies before their implementation in medical schools, and the need for further research to define the effective methods for delivering medical education in Child Health.